Parts of organs or tissues (such as a loop of intestine) can protrude into areas where they don’t belong. They push through openings or weaknesses in a muscle wall, so a bulge or lump appears. These bulges are hernias, which are common in children. Most common in babies and children are external hernias: inguinal (in the groin) and umbilical (near the belly button). Umbilical hernias are very common, especially in premature babies and babies with certain diseases. Inguinal hernias occur more in males than females and premature babies. Congenital diaphragmatic hernia and hiatal hernia are the most common internal hernias (inside the body) in children.
If hernias bulge only during pressure or strain, they’re called reducible and aren’t very harmful. Tissues trapped in an opening or pouch that can’t pull back are incarcerated hernias, which are serious problems. The most dangerous hernia is strangulated. In these, trapped tissue loses the blood supply and dies.
Indirect inguinal hernias, present at birth, are caused by mistakes during development. Direct inguinal hernias form after birth. Umbilical hernias occur when the umbilical ring doesn’t close properly. In other hernias, membranes, wall muscles, or other structures don’t form correctly or are hurt, so they slowly weaken.
Symptoms of inguinal and umbilical hernias are painless swellings, which may go away on their own. They’re most obvious with crying, straining, coughing, or standing. Inguinal hernias in boys can make the scrotum (sac holding testicles) large. In girls, labia (tissue around the vagina) can swell. Internal hernias may have no symptoms or may cause vomiting and heartburn. Incarcerated hernias cause tender firm masses, pain, vomiting, constipation, and irritability. Strangulated hernias lead to fever and swollen, red, inflamed, and very painful areas.
The health care provider uses the medical history and physical examination with the child lying down and standing. Blood tests or laparoscopy are rarely needed. Imaging studies in certain cases include X-rays and ultrasonography.
Treatment is based on type of hernia. Umbilical hernias usually cause no discomfort, and most tend to close on their own by age 1 or 2. Doctors can often easily push them back in. Doctors usually suggest waiting and watching these hernias. Operations are needed only if hernias don’t heal by age 4 or 5, or if they become trapped or block the intestines. Surgery, often outpatient, is used for inguinal hernias to prevent incarceration.
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